Fill and Sign the Order on Application for Temporary Removal of Child After Form

F.C.A §§1017, 1027 Form 10-2 (Child Protective -- Order on Application for Temporary Removal of Child After Petition Fi led) 6/2016 At a term of the Family Court of the State of New York, held in and for the County of , at New York on .P R E S E N T: Hon. Judge ..................................................................... In the Matter of Docket No. CIN #A Child(ren) under the Age of ORDER ON APPLICATION Eighteen Years Alleged to be FOR TEMPORARY “ Abused “Neglected by REMOVAL OF CHILD (After Petition Filed) Respondent(s) NOTICE : IF YOUR CHILD STAYS IN FOSTER CARE FOR 15 OF THE MOST RECENT 22 MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE A PETITION TO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILEBEFORE THE END OF THE 15-MONTH PERIOD. IF SEVERE OR REPEATED ABUSE IS PROVEN BY CLEAR AND CONVINCING EVIDENCE,THIS FINDING MAY CONSTITUTE THE BASIS TO TERMINATE YOUR PARENTAL RIGHTS. IF THE PETITION IS GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD AND YOUR CHILD MAY BE ADOPTEDWITHOUT YOUR CONSENT. THE NEXT COURT DATE IS [specify date/time]: THE PERMANENCY HEARING SHALL BE HELD ON [SPECIFY DATE/TIME]:1 A Petition under Article 10 of the Family Court Act having been filed with this Court alleging that the above-named child(ren) (is)(are)[check applicable box(es)]: “ abused “ neglected “ severely abused “ repeatedly abused ; 1 Specify a date certain not more than eight months from the dat e of removal. If the child has a sibling or half- sibling removed from the home, whose permanency hearing is sche duled before this Court, the date certain shall be the same as the date certain for t he sibling's or half-sibling's permanency hearing, unless the sibling or half-sibling was removed on a juvenile delinquenc y or PINS petition or unless he or she has been freed for adop tion. If the child is finally discharged from care on the scheduled date, the permanency hearing shall be cancelled. Form 10-2 Page 2 And the child (ren) [check applicable box(es)]: “ having been removed prior to this hearing pursuant to Family Court Act [specify]: “ §1021 “ §1022 “ §1024 “ having not been removed prior to this hearing; And a preliminary hearing having been held by this Court pursua nt to Section 1027 of the Family Court Act; and the following person(s) having appeared t o determine whether the child's interests require protection pending a final order of dispositi on [specify; check applicable boxes]: “ Respondent [specify]: “ with counsel “ without counsel [If Respondent not present]: Respondent “ was “ was not notified of this hearing. [If Respondent unrepresented]: Respondent “ waived “ did not waive the right to counsel. “ Respondent [specify]: “ with counsel “ without counsel [If Respondent not present]: Respondent “ was “ was not notified of this hearing. [If Respondent unrepresented]: Respondent “ waived “ did not waive the right to counsel. “ Attorney for the Child “ Petitioner “ Other [specify]: [Required in cases involving Nat ive-American children; check if applicable ]: “ And the following having been duly notified [check applicable box(es)]: “ parent/custodian “ tribe/nation “ United States Secretary of the Interior; And the tribe/nation having: “ appeared and participated as a party; “ appeared and declined to assume jurisdiction; “ appeared and requested transfer of jurisdiction; “ not appeared; The Court finds and determines that [Note : judicial findings must be made under I, II and III if temporary removal is GRANTED]: I. Criteria for Temporary Removal of Child(ren) [All three criteria (A, B and C ) must be met]: A. [check applicable boxes]: The “ parent(s) “ person(s) legally responsible for the child(ren) “ is absent and cannot be locate d after reasonable effort to do so; or “ was asked and refused to consen t to temporary removal of the child(ren) and “ was “ was not informed of an intent to apply for an order of rem oval; or “ consented to the temporary removal of the child(ren) OR “ The child(ren) was/were removed on an emergency basis, pursuan t to Family Court Act §1024; AND B. The child(ren) appear(s) to so suffer from abuse or neg lect by the “ parent(s) “ person(s) legally responsible for the child(ren)'s care ; an d Form 10-2 Page 3 AND C. Immediate removal or, if already removed, continued removal, of the child(ren) is necessary to avoid imminent danger to the child(ren)'s life or health becau se [specify facts and reasons, citing specific documents or evidence supporting findings]: II. Required “Best Interests” a nd “Reasonable Efforts” Findings [check applicable boxes and provide case-specific reasons in both A and B, below]: A. Continuation in, or return to, the child(ren)'s home “ would “ would not be contrary to the best interests of the child(ren) because [specify facts and rea sons]: This determination is based upon the following information [check applicable box(es)]: “ Petition “ Report of Suspected Child Abuse or Neglect “ Case Record, dated [specify]: “ Service Plan, dated [specify]: “ The report of [specify]: , dated [specify]: “ Testimony of [specify]: “ Other [specify]: B. Reasonable efforts, where appropriate, to prevent or el iminate the need for removal of the child(ren) from the home, and, if the child(ren) were removed p rior to the date of this hearing, to return them home safely [check applicable box and state reasons as in dicated]: “ were made as follows [specify]: “ were not made but the lack of efforts was appropriate [check all applicable boxes]: “ because of a prior judicial finding that the Petitioner was not required to make reasonable efforts to reunify the child(ren) with the Respond ent(s) [specify date of finding]: “ because of other reasons [specify]: “ were not made. This determination is based upon the following information [check applicable box(es)]: “ Petition “ Report of Suspected Child Abuse or Neglect “ Case Record, dated [specify]: “ Service Plan, dated [specify]: “ The report of [specify]: , dated [specify]: “ Testimony of [specify]: “ Other [specify]: III. Findings Regarding Alternatives to Removal to Foster Care : Form 10-2 Page 4 A. Based upon the investigation conducted by the Commission er of Social Services, [Check applicable box(es]: “ The following person [specify]: is a “ non-respondent parent “ relative “ suitable person with whom the child(ren) may appropriately reside [specify]:[Applicable to relatives and other suitable persons]: Such per son: “ seeks approval as a foster parent in order to provide care for the child(ren); “ wishes to provide care and custody for the child(ren) without foster care subsidy during the pendency of any order here in. “ may be a resource but not yet determined whether as foster par ent or custodian. “ There is no non-respondent parent, relative or suitable person with whom the child(ren) may appropriately reside. B. [Required]: Imminent risk to the child(ren) “ would “ would not be eliminated by the issuance of a temporary order of protection or order of protection directing the removal of [specify]: from the ch ild(ren)'s residence. NOW, therefore, it is [ check applicable box(es)]: ORDERED that the application for “ removal or “ continued removal of the child(ren) is hereby “ GRANTED OR “ DENIED; (and it is further) “ ORDERED that the child(ren)(is)(are) released temporarily to the following “ Respondent parent(s)[specify]: “ Non-respondent parent(s) [specify]: OR “ ORDERED that, pending further pr oceedings, the child(ren) shall be placed in the temporary custody of [check applicable box]: “ the Commissioner of Social Services of County; “ the Commissioner of Social Services of County to reside with [specify]: “ the following relative(s) or other suitable person(s) [specify ]: OR “ ORDERED that, pursuant to a petition filed under Article 6 of the Family Court Act, Docket # [specify]: , the child(ren) (is) (ar e) placed in the temporary custody of the following non-respondent parent [specify]: (and it is further) Form 10-2 Page 5 [Applicable to release to Respondent parent(s)]: “ ORDERED that the release to the Respondent parent be under the supervision of [specify]: [Applicable to release to Non-respondent parent(s) or temporary custody with relative or other suitable person]: “ ORDERED that, during the period of temporary release or custody, the non-respondent parent, legal custodian, relative or other suitable person shal l submit to the jurisdiction of the Court with respect to the child and shall cooperate with respect to m aking the child(ren) available for court- ordered visitation with Respondents, siblings and others, appoi ntments with the child(ren)’s) attorneys and clinicians and other individuals or programs providing serv ices to the children, visits (including home visits) by the child protective agency “ and the following additional direction(s) [specify]: pending further proceedings herein; (and it is further) “ ORDERED that, during the period of release or temporary custody, as applicable, the individual to whom the child(ren) have been released or with wh om the child(ren) have been placed into temporary custody under this Order may [check applicable box(es)]: “ enroll the child(ren) in public school in the applicable schoo l district and, upon verifying the Order and that the individual resides within the district, such district shall enroll the child(ren); “ enroll the child(ren) in their employer-based health insurance plan with the same rights as child(ren) for whom the individual is the legal guardian or custodian; and “ make decisions and provide any necessary consents regarding th e child(ren)’s: “ protection “ education “ care and control “ physical custody “ health and medical needs, provided that this Order does not limit any rights of the child(ren) to consent to medical care under applicable laws. “ AND IT IS FURTHER ORDERED th at, during the period of temporary release or temporary custody, as applicable, the child protective agency, social ser vices official or duly authorized agency shall provide the following services or assistance to the child (ren) and their family, pursuant to section 1015-a of the Family Court Act [specify]: 2 [ Additional orders regarding child(ren) removed from their paren t)s)]: “ ORDERED that the child(ren) shall be temporarily removed from the place where the child(ren) (is) (are) residing by any peace officer or agent of a duly authorized agency, society or institution and shall be brought to [specify]: pending further proceedings herein; (and it is further) “ ORDERED that: “ Hospital [specify]: “ Physician [specify]: is hereby authorized to provide such emergency medical or surg ical procedures for the child(ren) as may be necessary to safeguard the child(ren)'s life or health; (and it is further) 2 Services and assistance ordere d under F.C.A. §1015-a must be au thorized under the comprehensive annual services program plan in effect. Form 10-2 Page 6 [Required in child abuse cases unless petition commenced on the basis of medical examination and discretionary in child neglect cases, pursuant to FCA §1027 (g)]: “ ORDERED that the child undergo a medical examination, pursuant to Family Court Act §251 by the following physician [specify]: , which shall includ e the taking of colored photographs and, if appropriate, a radiological examination, the results of which, along with the photographs, shall be submitted to the Court; “ ORDERED that colored photographs be taken of areas of visible trauma to the child, if any; (and it is further) “ ORDERED that the child protective agency shall “ provide “ arrange for the following services or assistance to the (child) (child's family) pursuant to section 1015-a or 1022(c) of the Family Court Act [specify]: (and it is further) “ ORDERED within 24 hours of this order, the Commissioner of Social Services shall commence an investigation to identify and locate any non-respondent parent( s), inform them of the pendency of the proceeding and of the opport unity for seeking release or custody of the child(ren) , record the results of such investigation in the child’s Uniform Case Record and report theresults of the investigation to the Court, all parties and coun sels, including the child(ren)’s attorney, forthwith. Such search shall also include, but not be limited to, a person not recognized as a legal parent of the child(ren) but who has fil ed an instrument pursuant to section 4-1.2 of the Estates, Powers and Trusts Law acknowledgi ng paternity with the putative father registry, has a pending paternity petition or has been i dentified as a parent by the other parent in a written, sworn statement. Such search shall include, but not be limited to, thefollowing person(s) [specify, if known]: (and it is further) “ ORDERED that the Commissioner of Social Services shall investi gate whether there are any grandparents, other relatives or other suitable person(s) with whom the child(ren) may appropriately reside, including, but not limited to [specify]: ; shall inform them of the pendency of the proceeding, shall ascertain whether such person(s) wish toseek approval as foster parent(s) in order to provide care fo r the child(ren) or wish to provide care and custody for the child(ren) without foster care subsidy duri ng the pendency of any order herein; and shall record the results of such investigation in the child ’s Uniform Case Record; (and it is fu rther) “ ORDERED that, within 24 hours of t his order, the Commissioner of Social Services shall commence an investigation of the following relatives or other s uitable persons as foster parents [specify]: and thereafter app rove such person(s) to be foster parents, if qualified, and, if not, to report such fact a nd the reasons therefor to the Court, all parties and counsels, including the attorney for the child, forthwith. “ ORDERED that if the child absconds from the above-named custod ial person or facility, written notice shall be given within 48 hours to the Clerk of Court by the custodial person or by an authorized representative of the facility, stating the name of the child, the docket number of this procedure, and the date on which the child ran away; (and it is further) Form 10-2 Page 7 “ ORDERED that [specify Respondent (s) or other person(s) before the court]: (is)(are) required to comply with the terms and conditions specified in the order of protection, issued pursuant to Family Court Act §1029, annexed to this order and made a par t thereof; (and it is further) [Applicable Where Child is Native-American]:“ ORDERED that the following should be notified of this proceedi ng [specify]: the “ custodian of the child; “ tribe/nation; “ United States Secretary of the Interior “ ORDERED that in light of the assumption of jurisdiction by the tribe/nation, this petition is DISMISSED WITHOUT PREJUDICE. (and it is further) “ ORDERED that if the child remai ns in foster care or is directly placed pursuant to Sections 1017 or 1055 of the Family Court Act, a permanency hearing shall be held on [specify]:3 (and it is further) “ ORDERED ENTER _____________________________________ Judge of the Family Court Dated: PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FRO M THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM TH E DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER ISEARLIEST. 4 Check applicable box: G Order mailed on [specify date(s) and to whom mailed ]:_________ __________________ G Order received in court on [specify date(s) and to whom given]: _____________________ 3 Specify a date certain not more than eight months from the date of removal. If the child h as a sibling or half-sibling removed from the home, whose perm anency hearing is scheduled before this Court, the date certain shall be the same as the date certain for the sibling’s or half-sibling’s permanency hearing , unless the sibling or half-sibling was removed on a juvenile delinquency or PINS petition or unl ess he or she has been freed for adoption. If the child is finally discharged from care on the scheduled date, the permanenc y hearing shall be cancelled. 4 NOTE: If the parent or other pe rson legally responsible for a child was not present and given the opportunity to be represented by counsel at a hearing conducted pursuant to Family Court Act §1027, the parent or other person legally responsible m ay only challenge an order of removal of the child or children by requesting a hearing before the Family Court , not by appealing to the Appellate Division. The hearing before the Family Court must be held within three court days of the request, unless good cause is shown. See Family Court Act §1028.